The standard of oral care is a key indicator of the quality of care given, but more research and guidance on best practice is needed, says Clare Clarke
The effective provision of oral care is not a highly technical procedure, nor is it expensive in terms of resources. But evidence suggests that the importance of providing effective oral care is often not fully understood and can even be neglected.
This is unacceptable and may have a considerable impact on the quality of care delivered and how this is perceived by patients and carers. If an aspect of care is considered essential, it is reasonable to assume that without that care patients will be harmed.
Effective oral care should be considered a priority and of equal importance when compared with other highly technical interventions.
Recent media attention has focused on the poor quality or neglect of essential elements of care in certain hospital trusts or care settings. Patients’ mouths are highly visible and failure to provide oral care is instantly apparent. For example, dry cracked lips, a coated tongue and halitosis all indicate a lack of oral care, attention and a disregard for patient comfort.
The perceptions of relatives and carers regarding the quality of nursing care will often be influenced by or based on such indicators. Therefore, effective oral care can show caring and compassion.
Nurses are ultimately accountable and have a duty of care to minimise risk and potential harm to patients and promote well-being. In oral care, this involves carrying out and documenting a full oral hygiene assessment, preferably using a valid assessment tool, and planning care taking the individual patient’s needs into account. It also involves meeting this need by ensuring effective evidence-based preventative strategies and proactive interventions. This might involve referral for dental treatment.
If oral care is delegated to an unregistered practitioner, nurses remain accountable and must ensure that care has been given in an appropriate and timely manner. It is therefore vital that all healthcare workers understand the importance of effective oral care and the harm that can be caused by failure to provide it.
A limited number of studies have shown that education and training can raise awareness of the importance of oral hygiene. To perform a clinical skill competently, knowledge and understanding of the underpinning theory is essential. Ongoing oral care education and support for all healthcare workers is therefore vital to raise awareness of risk factors and the importance of preventative strategies and effective interventions.
To ensure effective oral care, it is essential that knowledge about an individual’s clinical condition, circumstances and preferences are integrated with research evidence and clinical expertise (Cullum et al, 2008). Previously, many aspects of care were based on ritual and intuition, and oral care is no exception.
Research evidence is limited and there is still some uncertainty about what best practice actually is, but studies have shown that many preventative oral hygiene interventions are effective, for example saliva substitutes and stimulants, and denture care. The development of evidence-based clinical guidelines would help to identify best practice and ensure consistency of care.
In conclusion, effective oral care is an essential element of care and a key quality indicator. Although research in this area is limited, it is vital that the findings of high-quality research are integrated into clinical decision-making. Awareness must continue to be raised through research, publication, education and training to highlight the importance of this essential element of care, otherwise patients will be harmed.
Clare Clarke is lecturer in adult nursing, Department of Health Sciences, University of York
Cullum, N. et al(2008) (eds) Evidence-based Nursing: An Introduction. Oxford: Blackwell Publishing.